Timing of heart surgery crucial, research shows

Valve replacement heart surgery should be performed earlier than previously thought for people with aortic stenosis – according to new research led by Professor Vasilis Vassiliou, honorary cardiovascular consultant at Royal Brompton and Harefield hospitals (RBHH).

Aortic stenosis is one of the most common and serious valve disease problems and is caused by a narrowing of the aortic valve opening.

Guidelines recommend replacing the narrowed valve once patients develop symptoms such as breathlessness, chest pains or blackouts. But many patients with aortic stenosis do not have symptoms even when they have severe narrowing of the valve and are therefore not eligible for valve replacement.

New research shows that these patients would benefit by undergoing a valve replacement before they suffer irreversible heart muscle damage.

Professor Vassiliou explained the motivation behind his research and said: “A lot of patients with severe aortic stenosis do not have symptoms and therefore are not eligible for valve replacement according to the current guidelines.

“For these patients without symptoms, the guidelines suggest a ‘watchful waiting’ approach and intervention is recommended only when they show symptoms or develop pump failure. We wanted to know if it would be better to perform surgery and replace the valve sooner rather than later.”

The research team carried out a review of research studies comparing early intervention (valve replacement) versus conservative management in patients with asymptomatic severe aortic stenosis.

They analysed data from all the available studies which involved a total of 3798 patients.

Prof Vassiliou said: “We found that early intervention, before patients have symptoms, is associated with lower risk of death and hospitalisation for heart failure.

“By the time the patients develop symptoms, there has likely been irreversible damage to the muscle of the heart. This in turn may preclude a worse prognosis and adverse outcomes even after successful intervention.

“The timing of aortic valve intervention is crucial. We hope that our findings may herald the beginning of a change in the management of aortic stenosis patients, enabling the intervention to take place more commonly whilst the patients are asymptomatic.  

“Ongoing trials investigating this high-risk population are anticipated to shed more light into the matter and in the identification of the optimal time of intervention,” he added.

The research was carried out in collaboration with the University of East Anglia, the University of Cambridge, the University of Edinburgh, the Norfolk and Norwich University Hospital, West Suffolk Hospital, Imperial College London, and the University of Leicester. It was partly funded by the Wellcome Trust.

Click the link to read the paper: Management of asymptomatic severe aortic stenosis: A systematic review and meta-analysis